Reflections - How GLP-1s Changed My Thinking On Medicine (Dr. Alexandra Sowa episode)
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This is Smart People Podcast, a podcast for smart people, where we talk to smart people, but not necessarily done by smart people. Hello, welcome to Smart People Podcast Reflections Edition. Chris Demp here, thanks for tuning in. In this episode, I am reflecting upon my most recent episode where I interviewed Dr. Alexandra Soa.

And we talked about, among other things, her new book called The Ozempic Revolution. And before we get into it, I just have to say that, number one, I'm really enjoying this style. Let me know if you are as well. Just hit me up, smartpeoplepodcast at gmail.com.

And one of the reasons is because as I reflect on it, I think about the impact this podcast and this process and this business has had on my life and hopefully on many of your lives, those listening. And this episode was no different. Now, yes, this Reflections style episode is new, and so it is changing.

But as of right now, I think here's what I've settled on. So first, I'm going to tell you why I chose this author slash topic. I'm going to tell you second in the second section about my experience with the guest, give you some behind the scenes there. And then third, and probably most importantly, but maybe not, is my takeaways from the episode.

So let's get into our first section on why this topic, why this episode. You know, personally, I'm not planning on ever going on GLP-1s. Nothing wrong with them. I just, it's just not there. But that is not the point of this podcast. And I didn't do it just because many of you might be considering it. I did it because GLP-1s are both a part of current culture and a symbol of what is to come.

They are one of the first of the magic pills or shots, as I allude to, in this striving towards health in the post-biohacking AI revolution, if you will. I mean, if you would have said 30, 40 years ago, hey, you can take a shot and like with pretty little side effects guaranteed to healthily lose weight.

I think people would have been like, yeah, that's crazy. But that is what these JLP1s are, or at least what they're being touted as. So I wanted to understand that. I wanted to understand this world of metabolic health that I'm not ultra familiar with. And I wanted to do it with somebody who

truly was in this world before GLP-1s became a thing. And so that's how I came across Dr. Soa. Now let me talk about my experience with her and having her on the podcast. So first is, you can tell she's busy. I mean, she is running a business. She is bossing things. You know what I mean? She's really getting it done. She's a go-getter. Second, you can tell, and I really...

I think I've put in the 10,000 hours to understand people. She is the perfect mix of like really knows her stuff and is in it for the right reasons and also wants to accomplish in the field. And so why that helps is if you're a patient or if you're a potential purchaser of her book or her products or her services, I really do think that

that she is quote unquote expert and experienced enough to bring that real science to the table, but also is new agey enough to understand that old science isn't the only thing and she's relatable and she's seen it all, but she's not dogmatic.

We talked off air a little bit about the attention economy and how both of us actually with our platforms could go on and just kind of say divisive stuff and be very bombastic and probably do better from a business standpoint.

And both of us refuse to do that. I mean, think about it, right? She is in the weight loss world. She could be absolutely selling her soul, especially with her background. But that is not her goal. And I always appreciate people like that.

Also, one thing she said after the interview was, you know, Chris, I probably answered questions on this podcast I've never answered before. And that's actually a common refrain. And I think that people who say that are being genuine. And it's because I don't really go in with a standard playbook or game plan. I'm trying to make it unique, but usable. So I think we did that as well. And trust me, I will tell you,

When the conversations were hard or when perhaps I didn't even like them. And, and, and, uh, and I think that's important for this reflection to have any real meaning, but in this case, I'll sum it up as this. I didn't know what I was going to get, especially a subject I'm kind of unfamiliar with and maybe not directly interested in. And I was very, very pleasantly surprised, uh,

And that's what I'm going to get into here is why was I pleasantly surprised? What were my takeaways? And it really starts with this.

It starts with even during the episode, I was thinking like, why did I choose this again? And I realized it is because I like to be surprised by knowledge. I like to be surprised in what I should know or should learn about. And a perfect example here is I fundamentally do not and did not understand the new science of knowledge.

metabolic health versus dysfunction. As I allude to in the interview, it's not something I've quote unquote had to worry about, but it doesn't mean I don't want to know it. And so my first takeaway is the fact that many people's common struggle with weight gain

actually is caused by what's called neurohormonal dysregulation. In fact, the quote from the episode is neurohormonal dysregulation is what is at the root of a lot of waking your brain, gut and hormones. Stop communicating effectively, creating a cycle where weight gain begets hunger, fatigue and more waking.

Okay, so what is this neurohormonal dysregulation? Essentially, this is referring to an imbalance, hence the dysfunction, in the interaction between the brain, which is the neuro part, and the hormones, which is the hormonal, that regulates various physiological processes. So this is things like hunger, metabolism, and weight management.

Things such as hunger signals. So the brain is the thing that tells us if we're hungry or full. It does so through chemical release. And if that's not working well, you have neuro hormonal dysregulation causing you to eat too much or too little.

What? I mean, yeah, that makes sense, but never really thought about it. So things like actual hormones called GLP-1, ghrelin, which many of you have heard of, that's the hunger hormone, leptin, which is about satiety,

They go through the gut brain access and tell your brain, hey, you're hungry or not. And that gets out of whack. So causing somebody who's not hungry to actually overeat and gain weight and not understand why. Perhaps more commonly talked about is this idea of insulin. So insulin resistance disrupts the body's ability to process and store glucose effectively, which fuels weight gain. Insulin is a hormone. Yet again, neuro hormonal dysregulation.

So I know we start the episode off with a quote that I mentioned, which is really the idea of calories in, calories out is outdated. But now the new science is much around this idea of the hormones that impact the way you metabolize food. That was really cool for me to learn. Second big takeaway is that only 12% of American adults are considered metabolically healthy. Now,

that means that I'm probably not metabolically healthy. You're probably not if you're listening, right? So I don't want to be hyperbolic about that. It is just this realization that the way we metabolize food and turn it into energy is complicated and one where it has a lot of downstream effects and we should probably learn about it. The way Dr. Soha defines metabolic health

is a state where the body effectively processes food into energy and maintains balance in certain physiological functions. So these are things like healthy HDL, low triglycerides, ideal fasting blood sugar, healthy blood pressure, and appropriate waist circumference. Those things combined really help make up the picture of how your body turns food into energy. And again,

I like this idea. I like the idea of understanding the things that help us be better. Now, she recommends a lot of tests. I'm not saying go get those, but if you're listening and wanted to hear them again, here's what they are. Fasting insulin, the HOMA-IR score, lipid panel, hemoglobin A1c,

thyroid panel inflammation marker, which is high sensitivity C-reactive protein, advanced cholesterol testing, which is APOB and APOA1, and coronary calcium scan, which is another cool takeaway. My dad just did it. Look, I'm not a doctor here. I only play one on The Simpsons, but that's a joke.

So check this out, right? A lot of people are being told they need to go on statins and they're, this is high and that, that is high. There's this test that's getting a lot of, um, airtime these days, the coronary calcium scan. And basically what they do is they take a picture or an x-ray or something of your arteries and they look for calcium or plaque buildup. And that can tell you if your cholesterol is actually leading to potential heart problems. Example is,

My dad has been on the cusp of like needing a statin and he doesn't want to do it. And he went and he got this coronary calcium scan and they said 0%. Like you have no signs of plaque or calcium or heart disease risk. So despite the fact that your cholesterol might be slightly elevated and you might, or some people might recommend you go on a statin, you don't need to. And it costs like 200 bucks. Really cool.

So that was kind of another whole area that I enjoyed. But my final key takeaway and the thing in its entirety of this interview that I enjoyed is this idea. Specifically, when it comes to health, things are not binary.

What I mean by that, it's not good or bad. It's not you should do it or you shouldn't. And specifically, it's not should you take this medication or should you not? And I'll tell you why this matters, especially for me. I have always disliked medication. I thought that, you know, nature is best and you got to do things through hard work and things like GLP-1s would be cheating amongst other things.

However, after talking to Dr. Soa, I realized this. Let's say you're dealing with neuro hormonal dysregulation. Don't know how you got there. Let's say it's genes or a lifetime of bad habits, whatever it is, but your body is kind of messed up in the way it metabolizes food. And that has caused you to over years and decades put on a lot of weight, 50, 60, 70, 80, a hundred pounds.

Now that weight is catching up to you. It is causing downstream effects, diabetes, cholesterol issues, lack of energy or lack of exercise, aches and pains. All the things that we know can come with weight gain. When presented with GLP-1s, which by the way, are not a miracle drug per se. They don't come without any side effects. But when presented with GLP-1s,

you at least have the option to say, this drug might not be perfect, but it is better than the things I'm dealing with with the weight gain. So by taking this drug, do I add another unknown or potential side effects? Yes. But does it help me mitigate the diabetes or insulin resistance or lack of exercise, lack of energy, lack of self-esteem?

potentially. And now I get to weigh those two things and say, which one makes more sense for me? And that is what I took away. It's not black and white. And so even though this isn't something specific I have to deal with, there are many areas in my life, health related. I do have to look at it this way. And I'll end it with this. I don't know who said it could be like David Goggins. I'm not sure. Could be a past guest, but it's this idea of choose your heart.

It's this idea that we all have issues, we have things going on, and nothing's easy. The idea is to look at the difficult things we have to do and choose which one would we rather do. And so for some, taking that GLP-1, yes, there might be some downstream effects. Yes, you might have to take it forever. But is it better for you in the long run than the effects of being overweight, obese, etc.?

nuance. We need more of that in our lives. We need more of it in our world, in our discussion. And this was another reminder of that. Hope it makes sense. Let me know what you think. Smartpeoplepodcast.gmail.com. Tell a friend, send them this episode. Make sure you follow us and subscribe wherever you listen to podcasts so you don't miss another one. We've got some good ones coming up in the new year of 2025. See you next week.